Information Collection

Ssa-454-icr

IC 189922 under ICR 200907-0960-006 · OMB 0960-0072.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0072 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-454-BK SSA-454-ICR	Form
SSA-454-ICR Cover Letter (Mock Up).pdf	Instruction
SSA-454-BK Continuing Disability Review Report SSA-454-ICR-Mock-Up (F).pdf	Form

IC Title:

SSA-454-ICR

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1589 20 CFR 416.989

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-454-BK	Continuing Disability Review Report	SSA-454-ICR-Mock-Up (F).pdf		No		Paper Only
Instruction			SSA-454-ICR Cover Letter (Mock Up).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.